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Coma and Disorders of Consciousness
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
(STORY 3) A car accident led to a coma in an 18-year-old man, and he seemed unlikely to recover. His score on a scale used to assess coma severity was so low that his survival was “very unlikely,” but his family kept him on life support with the hope that he would improve (p. 62). And he did—against the odds, he slowly improved. By the end of the second month, he was no longer on ventilation to assist his breathing. By the third month, he had improved to a minimally conscious state and began to groan in response to painful stimuli. At around seven months, he began “situation-independent screaming,” meaning that he would, at seemingly random times, begin screaming (p. 63). This unfortunate symptom lasted for around four weeks, and painkillers did not seem to help. At eight months, he could close his eyes when asked to do so, and at nine months he began to be able to communicate via blinking and then nodding or shaking his head. He was then able to go home, where he continued intense rehabilitation efforts. He often participated in several hours per week of therapies for speech and movement. Around 18 months after the accident, he had made major improvements in cognitive functions such as memory, although he continued to have difficulties with some other types of tests. Ten years following the accident he still showed some signs of slowed speech and reduced memory but, otherwise, he was living an independent life with a nearly full recovery (Steppacher et al., 2016).
Assessment of Co-occurring Disorders, Levels of Care, and ASAM Requirements
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Elizabeth Reyes-Fournier, Tara G. Matthews, Tom Alexander
Phil is a 56-year-old African American man who has recently been arrested for driving under the influence. He is a married father of two boys and owns a power washing company. His wife and his primary care doctor have warned him against drinking. As his diabetes continues to worsen and the pandemic shut down his business temporarily, he has found himself drinking more and more. His arrest followed a car accident in which his car was totaled. His neighbors called emergency services when he crashed into their mailbox and did not get out of the car. Emergency services drove him to the hospital, and a blood test revealed a.30 blood alcohol content (BAC). Phil woke in the hospital to find that he was handcuffed to the bed with no recollection of what had happened. The hospital doctors have advised the police that Phil needs to be detoxed prior to being taken to jail to prevent any dangerous withdrawal symptoms and to stabilize his blood sugar. The police are eager to arrest him as this is not the first time he has been in trouble with the law. Over the past year, he has received a drunk in public charge and a possession of marijuana charge when he was found wandering his neighborhood at 3:00 a.m.
Day 4
Published in Bertha Alvarez Manninen, Dialogues on the Ethics of Abortion, 2022
Ok, let me put it another way. Suppose that you were in a car accident that you caused and that resulted in someone getting run over. Say he lost a lot of blood and needs a transfusion, that you can provide. Don’t you have at least some responsibility to the person you harmed, exactly because you caused him to be in a state of dependence given your negligence?
Pharmacokinetics and safety of candidate tocilizumab biosimilar CT-P47 versus reference tocilizumab: a randomized, double-blind, single-dose phase I study
Published in Expert Opinion on Investigational Drugs, 2023
Kyung-Sang Yu, Byungwook Kim, Dongseong Shin, Min Kyu Park, Jun Gi Hwang, Min-Gul Kim, Hyewon Chung, JongLyul Ghim, Jae-Yong Chung, Josef S. Smolen, Gerd R. Burmester, SungHyun Kim, YunJu Bae, DaBee Jeon, JaeKyoung Yoo, GoEun Yang, JiHun Bae, Edward Keystone
TESAEs were experienced by two (1.4%) and one (0.7%) participants in the CT-P47 and EU-tocilizumab groups, respectively (Table 4). Those in the CT-P47 group were of grade 2 in intensity: one participant tested positive for COVID-19 and subsequently discontinued the study due to isolation at a treatment center. The participant received non-steroidal anti-inflammatory drugs and cough remedy and was later discharged. In the second case, a participant experienced pain in an extremity following a car accident. This participant received acupuncture and electrotherapy and completed the study. Both events were considered to be unrelated to study drug. The TESAE in the EU-tocilizumab group was a headache of grade 3 intensity. The participant was hospitalized and received symptomatic treatment with analgesics, tranquilizers, antidepressants, antiemetics, and antihypertensives. The event was considered possibly related to study drug and the participant completed the study. There were no TEAEs leading to discontinuation of the study drug or death (Table 4).
Thoracal arachnoiditis ossificans associated with multifocal motor neuropathy: a case report
Published in British Journal of Neurosurgery, 2023
Vladimir Baščarević, Dragoslav Sokić, Aleksandar J. Ristić
Twenty-seven years prior she had a combat-related injury after rocket-propelled grenade and hand grenade explosions. She had suffered blast concussion but had made a full neurological recovery but had several pieces of retained shrapnel in her body. Three years after that incident she sustained another concussion, back contusion and fracture of two thoracic vertebras (T4 and 5) in a car accident which was treated conservatively. In the following years, periodic sensations appeared mainly during sleep time (“severe pressure around chests”). Hashimoto thyroiditis was diagnosed ten years ago, but thyroid hormone levels were normal on several occasions. At the time of the presentation to our institution, she was able to walk with a cane without aid or rest for 100m limited by progressive lower limb weakness and stiffness. She also reported muscle wasting and weakness in both hands, predominantly the right one with the formation of a claw hand during the last two years.
Enteral combined with parenteral nutrition improves clinical outcomes in patients with traumatic brain injury
Published in Nutritional Neuroscience, 2022
Xiaomin Li, Yafeng Yang, Zheng Feei Ma, Shan Gao, Yuan Ning, Ling Zhao, Zhangya He, Xiaoqin Luo
A total of 61 patients with TBI were included in this study. There were 47 males (77.0%) and 14 females (23.0%), with an average age of (48.18 ± 13.17) years (range: 18–73 years). There were 28 and 33 patients in the control group and observation group, respectively. The causes of injury in the two groups of patients were: car accident injuries in 33 cases (54.1%) followed by bruise injuries in 20 cases (32.8%) and fall injuries in 8 cases (13.1%) (Table 1). The range of hospital stay was 2–176 days, with an average of 37.1 days. There were 68 cases (100%) with NRS2002 score of >3 and their GSC scores ranged from 3–15 on admission (with an average of 7.92). Nutrition therapy in patients was started between 1–7 days after surgery, with an average of 2.8 days. There were two types of enteral nutrition support: oral administration (n = 5) and nasogastric tube feeding (n = 29). The duration of enteral nutrition treatment ranged from 2–14 days, with an average of 5.7 days. During the hospitalization period, 28 patients (45.9%) developed pulmonary infections, 8 patients (13.1%) had intracranial infections, 5 (8.2%) had stress ulcers, and 7 (11.5%) had diarrhea.